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In the news

From the February ACP Hospitalist, copyright © 2009 by the American College of Physicians

Data on errors collected but rarely used to improve

Almost 90% of hospitals nationwide collect information about medical error-related patient injury or death, but only about 20% have procedures in place to address the problems and make improvements, according to a study published in the journal Quality and Safety in Health Care.

The study, conducted by the Agency for Healthcare Research and Quality, was based on a survey of risk managers at more than 1,600 hospitals in an effort to estimate how many hospitals report patient injuries or deaths that result from medical errors, the status of reporting practices, how information on reported occurrences is shared and if it is used for practice improvement.

While virtually all the surveyed hospitals’ systems had the capability to record type, place and time of errors, only 32% of hospitals have established “supportive environments” that allow staff to anonymously report patient injuries or deaths resulting from errors and only 13% have comprehensive staff involvement in the error reporting process.

The survey also found that physicians often do not report adverse events because of liability, embarrassment and time constraints. The study authors point out that physician participation may be higher than observed, however, if physicians are actually asking other staff members, such as nurses, to report identified adverse events, rather than doing it themselves.

Results will provide baseline information to enable tracking of trends in adverse-event-reporting practices across the country as well as to assess the effects of the Patient Safety and Quality Improvement Act of 2005, which was enacted to reduce the fragmentation of information on reported patient safety events and issues.

Heart disease deaths drop but obesity, inactivity still major risks

Deaths from heart disease and stroke fell by about 30% between 1999 and 2006, according to data released in the American Heart Association’s 2009 statistical update.

While the reductions are significant, there has not been a similar decline in major risk factors for cardiovascular disease (CVD) and stroke, and some are on the rise, said the AHA’s president in a news release. For example, high blood pressure, high cholesterol and tobacco use are under better control but much work remains to be done to reduce obesity, diabetes and physical inactivity in order to prevent the death rate from rising again, said the release.

The AHA’s update also includes data on coronary artery calcification (CAC) scores and carotid intima-media thickness, which can be early warning signs of CVD. A recent National Heart, Lung and Blood Institute study found that 15% of men and 5.1% of women already had CAC and that older adults with CAC are much more likely to suffer a coronary event, especially if their CAC scores exceeded 100.

Other statistics contained in the update include:

• Between 1999-2000 and 2005-2006, average total cholesterol levels for men age 40 or older and for women age 60 or older declined from 204 mg/dL to 199 mg/dL.
• 62% of adults who responded to the 2006 National Health Interview Survey reported no vigorous activity lasting at least 10 minutes per session.
• The presence of overweight (BMI-for-age values at or above the 95th percentile) in adolescents aged 12 to 19 increased from 6.1% in the 1970s to 17.6% in 2003-2006.

The full update is available online in the Jan. 27 issue of AHA’s journal Circulation.

Cardiology criteria guide therapy over intervention for chest pain

Joint criteria offer a practical tool to help physicians choose between therapy and intervention for chest pain, criteria that focus on cardiac treatment rather than on diagnostic testing.

“Appropriate Criteria for Coronary Revascularization,” a document created jointly by several medical groups, presents information from patients seen daily by typical patients, not just those included in the clinical trials used to form guidelines. Appropriate use criteria also present easily understood clinical scenarios that characterize patients according to:

• symptom severity and type,
• how much cholesterol plaque has built up and in which arteries,
• ischemia, and
• whether the patient is already taking the right heart medications in the right dosages.

Revascularization was considered appropriate if the expected improvements in survival, symptoms, functional status and/or quality of life outweighed the possible risks, according to a news release from the Society for Cardiovascular Angiography and Interventions (SCAI). In most cases, the panel considered revascularization as either bypass surgery or percutaneous coronary intervention. Because evidence supported either procedure for patients with advanced coronary disease, each revascularization method was independently rated.

The panel determined that revascularization would be inappropriate in a patient who had plaque build-up in one or two arteries, experienced symptoms only during heavy exercise, had a small amount of heart muscle at risk and was not taking medication to help control symptoms. However, revascularization is appropriate if a similar patient had severe symptoms despite already taking medication.

The criteria were published online and appear in the Feb. 10, 2009, issue of the Journal of the American College of Cardiology. They were jointly developed by the American College of Cardiology, SCAI, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and American Society of Nuclear Cardiology. They have been endorsed by the American Society of Echocardiography, Heart Failure Society of America, and Society of Cardiovascular Computed Tomography.

In the News is a product of ACP HospitalistWeekly, an e-newsletter provided every Wednesday by ACP Hospitalist. If you’re not already receiving ACP HospitalistWeekly, contact Customer Service at 800-523-1546, ext. 2600, or directly at 215-351-2600 (M-F, 9 a.m. to 5 p.m. EST) or e-mail us.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated